Chithandizo cha chithandizo cha khansa yofooka chimadalira pa sitepe ya khansa ndipo ingaphatikizepo opaleshoni (kuchotsa mbali kapena mankhwala onse), chemotherapy, mankhwala othandizidwa ndi ma radiation, mankhwala othandizira, kapena kuyezetsa kuyesayesa kwa mankhwala kapena mankhwala atsopano.
Chithandizo, komabe, sichimangokhalira kuchiza khansara, komanso chithandizo chochizira kapena chithandizo chothandizira anthu kuthana ndi zotsatira za thupi, zamaganizo, ndi zauzimu za khansara-ndizofunikira kwambiri.
Kusankha Chithandizo Chachipatala
Kaya muchita opaleshoni kapena mankhwala ena, kupeza malo abwino a khansa ndi ofunikira. Kuphunzira kwa 2017 mu Annals of Surgery kunatsimikizira zomwe maphunziro oyambirira asonyeza. Ochita kafukufuku anapeza kuti anthu omwe ali ndi khansa yoopsa kwambiri omwe amayenda maulendo ataliatali kupita ku malo opatsirana kwambiri a khansa amalandira chithandizo chosiyana kwambiri komanso amakhala ndi zotsatira zabwino kusiyana ndi omwe amakhala pafupi ndi nyumba za khansa zomwe zimathandiza anthu odwala matendawa.
Mungaganizire kufunafuna lingaliro pa imodzi mwa zikuluzikulu za National Cancer Institute-malo okhudzana ndi khansa; malo omwe amachitira anthu ambiri omwe ali ndi khansara yowopsya (komanso kwa opaleshoni, amachita opaleshoni yambiri).
Njira Yothandizira ndi Stage
Musanayambe njira zothandizira zothandizira, ndizothandiza kukambirana za mankhwala omwe amagwiritsidwa ntchito pamagulu osiyanasiyana a matendawa.
Zimasiyana mosiyanasiyana.
Anthu awiri omwe ali ndi gawo lomwelo la matendawa, mwachitsanzo, akhoza kukhala ndi khansa m'madera osiyanasiyana omwe angafune mankhwala osiyana. Ngakhale ndi khansa yomwe ikufanana ndi malo, malo, komanso anthu omwe ali ndi thanzi labwino, nkofunika kuzindikira kuti palibe khansa ziwiri zofanana.
Izi zinati, njira yowonekera ndi yotsatira.
Gawo 0
Gawo 0 ( carcinoma in situ ) kapena gawo laling'ono kwambiri 1A khansa nthawi zina amachotsedwa kudzera kumapeto. Ku United States (mosiyana ndi mbali zina zadziko), khansara yokhayokha ndi yachilendo ndipo sichipezeka pamtengowo nthawi yoyambirira kuti kuchotsa kosakanikirana ndi kotheka. Opaleshoni ingagwiritsidwenso ntchito kwa zotupazi.
Gawo 1
Kuchita opaleshoni kawirikawiri ndikumana ndi chisankho chokhala ndi khansa yoyamba 1 ndipo kungakhale njira yokhayo yothandizira nthawi zina.
Gawo 2 ndi 3
Chemotherapy ndi radiation (kapena chemotherapy yekha) kenako opaleshoni ndi njira yofala kwambiri, ngakhale kuti nthawi zina opaleshoni yokha, kapena chemotherapy yekha, ingagwiritsidwe ntchito. Pakalipano pali kutsutsana pa nkhani yoti kaya anthu omwe ali ndi squamous cell carcinomas omwe ali ndi mayankhidwe athunthu (palibe umboni wa zotupa) pambuyo pa chemotherapy akufunikira opaleshoni.
Gawo 4
Ndi mankhwala a khansa ya 4A, chemotherapy ndi ma radiation nthawi zina amatsatiridwa ndi opaleshoni (ngati chotupa chikuyankha bwino). Pachifukwa cha 4B khansa, chemotherapy nthawi zina ikhoza kuyankha mwachidwi.
Anthu ena amadandaula kuti, chifukwa cha msinkhu, chithandizo chidzakhala champhamvu kwambiri, koma anthu okalamba (opitirira zaka 80) omwe ali ndi thanzi labwino amawoneka kuti akulekerera chithandizo cha matenda ochepa kwambiri ndipo amakhala ndi miyoyo yofanana ndi ya achinyamata.
Opaleshoni
Mukapezeka m'zigawo zoyambirira za matendawa, opaleshoni ikhoza kupereka chithandizo. Musanayambe kufufuza opaleshoni, mosamala kwambiri. Mwamwayi, ngati khansara yayamba kupyola pamimba, opaleshoni siimapulumuka koma imachepetsa moyo. Choncho ndikofunikira kudziwa kuti ndani angapindule ndi opaleshoni.
Chofunikira kwambiri ndicho kupeza dokotala wa opaleshoni yemwe ali ndi zodziwa kwambiri pakuchita opaleshoniyi. Ngakhale malo akuluakulu a khansa ali ndi mwayi wambiri wochita opaleshoni ochita opaleshoni, ndikofunikira kutenga nthawi "yofunsana" ndi dokotala yemwe akuchita opaleshoniyo pazomwe amamuchitikira ndi opaleshoni yowopsya.
Ndondomeko
Esophagectomy, opaleshoni yomwe imachitidwa pofuna kuchotsa khansa ya asophageal, imatanthawuza kuchotsedwa kwa onse kapena mbali ya chigawocho. Kwa khansa zina, makamaka zomwe zili m'munsi, mbali ya mmimba imachotsedwanso. Kuonjezera apo, ma lymph nodes omwe amakhala pafupi amachotsedwa ndi kutumizidwa ku labata kuti ayang'ane umboni uliwonse wa khansa.
Pambuyo pa chigawochi, kuchotsa mimba kumathamangitsidwa kumtunda waukulu (mawu akuti kusoka pamodzi ndi "anastomosis"). Ngati mbali yaikulu yamagetsi imachotsedwa kotero kuti cholembera ndi chovuta kapena chosatheka, chigawo cha m'mimba chingachotsedwe ndikuyikidwa pakati pa pamwamba ndi m'mimba.
Esophagectomy ikhoza kuchitidwa m'njira ziwiri:
- Tsegulani esophagectomy: Mwa njira yotseguka, chigwirizano chachikulu cha chikhalidwe chimapangidwa kaya m'khosi, chifuwa, kapena mimba (kapena nthawi zina zimaphatikizapo zonse zitatu) zomwe zimapezeka.
- Zovuta kwambiri kuti isophagectomy iwonongeke: Pakapita kanthawi kochepa, katemera kakang'ono kameneka kamayikidwa m'khosi ndi pachifuwa. Chiwerengero cha (ndi kamera) chimayikidwa kudzera mu zochitikazi ndipo opaleshoni imachitidwa kupyolera muyeso. Kuchita opaleshoni yochepa chabe kumachitika kokha ndi zotupa zazing'ono zochepa kwambiri.
Zotsatira Zotsatira ndi Zovuta
Kuchotsa mbali ya chiphaso ndi opaleshoni yaikulu ndi zovuta ndizosazolowereka. Pa opaleshoni, zoopsa zambiri zimaphatikizapo kutuluka magazi ndi anesthesia monga mavuto osagwirizana ndi mtima ndi mapapo.
M'masiku omwe akuchitika opaleshoni, mazira amagazi amapezeka kwambiri ( mavitamini otsika kwambiri ) ndipo nthawi zina amachoka ndikupita kumapapo ( pulmonary emboli ). Matenda monga chibayo amapezeka pafupipafupi pamene amachira ndi kutuluka (ndi matenda omwe amabwera pambuyo pake).
Kwa nthawi yayitali, anthu ena amakhala ndi mantha chifukwa cha kuwonongeka kwa mitsempha mu chifuwa pa opaleshoni. Kuwonongeka kwa mitsempha kungapangitsenso kusintha kwa motility mu kapamwamba kakang'ono kakang'ono kamene kamayambitsa kunyoza ndi kusanza. Popeza kuti m'mimba mwa mitsempha ya m'mimba yomwe imathandiza kuti mimbayo isalowe m'mimba, nthawi zambiri imachotsedwa kapena kuwonongeka, kupsa mtima kumakhala kofala, ndipo anthu ambiri amafunika mankhwala a asidi reflux.
Chemotherapy
Chemotherapy imagwira ntchito poyambitsa kupatukana mofulumira maselo ndipo ingaperekedwe mwa njira imodzi mwa khansara yofooka. Izi zikuphatikizapo:
- Mankhwala a Neoadjuvant: Neoadjuvant chemotherapy amatanthauza kugwiritsa ntchito mankhwala a chemotherapy asanayambe opaleshoni kuti athe kuchepetsa kukula kwa chotupa.
- Mankhwala a Adjuvant: Adjuvant chemotherapy amatanthauza chemotherapy yoperekedwa pambuyo pa opaleshoni. Ngakhale ngati sakuwoneka kuti ali ndi khansara yatsalira pambuyo pa opaleshoni, masango ang'onoang'ono a maselo a khansa akhoza kukhalapo ndipo amachititsa kubwereranso mtsogolo. Chemotherapy atatha opaleshoni ingachepetse chiopsezo cha kubwereza ndikupulumutsira anthu ena.
- Mankhwala othandizana ndi mankhwala: Palliative chemotherapy amatanthauza kugwiritsa ntchito chemotherapy pofuna kuteteza zizindikiro ndi kukulitsa moyo ndi siteji 4, koma osati kuchiza matenda. Pakalipano, mankhwala a chemotherapy (ngakhale atakhala ndi ma radiation) angawonjezere kutalika kwa kupulumuka koma sangathe kuchiza matendawa.
Ngati opaleshoni ikuganiziridwa, njira yowonjezera ndiyo kupereka chemotherapy (popanda mankhwala opangira ma radiation) musanachitike opaleshoni (adjuvant chemotherapy kapena chemoradiation). Pali zifukwa zambiri za izi.
- Dokotala wanu akhoza kutsimikiza kuti chemotherapy ndi yothandiza m'malo mophunzira opaleshoni ngati siili.
- Chemotherapy kawirikawiri amalekerera bwino kwambiri asanachitire opaleshoni kusiyana ndi pambuyo pa opaleshoni.
- Kachilombo ka mankhwala a Neoadjuvant angayambe kuchepa (pangitsani kukhala ochepa) kuti opaleshoni ikhale yosavuta kuchita.
- Potsirizira pake, kwa anthu ena (makamaka omwe ali ndi squamous cell carcinomas), chotupacho chikhoza kutha kotero kuti opaleshoni siyenela.
Mankhwala a Chemotherapy omwe amagwiritsidwa ntchito nthawi zambiri amagwiritsa ntchito Paraplatin (carboplatin) ndi Taxol (paclitaxel) kapena Platinol (cisplatin) ndi Camptosar (irinotecan). M'mbuyomu, mankhwala 5-FU (5 fluorouracil) amagwiritsidwa ntchito nthawi zambiri, koma amakhala oopsa kwambiri.
Chemotherapy Side Effects
Monga momwe zilili ndi mankhwala ambiri a khansa, nkofunika kukumbukira kuti zotsatira zoyipa za mankhwala omwe mnzanu kapena wachibale angakhale nawo kale, sizikugwiranso ntchito pa mankhwala amasiku ano. Mankhwala a chemotherapy amaperekedwa mozungulira (mwachitsanzo, milungu itatu iliyonse), kwa miyezi inayi kapena isanu ndi umodzi.
Zotsatira zake zambiri zimabwera chifukwa cha mankhwala omwe amapha maselo omwe amagawanika mofulumira pamodzi ndi maselo a khansa. Zotsatira zoyipa zambiri zimaphatikizapo:
- Magazi oterewa amawerengera: Kuchepa kwa magazi ( fupa la mafuta amtundu wa mafupa ) kumabweretsa chiwerengero chochepa cha maselo a magazi ( neutropenia ), kuchepa kwa maselo ofiira a magazi ochepa ( anemia ), ndi chiwerengero chochepa cha platelet ( thrombocytopenia ).
- Kutayika tsitsi: Mankhwala osokoneza ubweya samagwiritsidwa ntchito kawirikawiri ndi khansa (kupatulapo Camptosar) koma nthawi zambiri amachititsa tsitsi kupatulira.
Nsowa ndi kusanza : Onani pansipa.
- Mphuno ya m'mimba: Kusinkhasinkha, kupweteka, ndi kupweteka, kawirikawiri kumagawidwa "kusungira ndi kugulitsa".
- Zilonda zam'mimba ndi kulawa zimasintha
- Kutopa
Monga momwe mankhwala osokoneza bongo amadzigwiritsira ntchito lerolino ndi ochepa poizoni, kasamalidwe ka zotsatira zake zakhala bwino kwambiri. Anthu ambiri ali ndi nseru zochepa kapena zosasangalatsa ndi kusanza ndi mankhwala opatsirana. Palinso majekeseni omwe angapangitse kuchulukitsa selo loyera la magazi ngati kuli kofunika (ngakhale kuli kofunikira kuti mudziwe njira zothetsera chiopsezo cha matenda pa chemotherapy ).
Matenda a mphuno (PN), ndi imodzi mwa zizindikiro zowopsya za chemotherapy za khansa ya m'mimba komanso nthawi zonse. Mankhwala ogwirizana kwambiri ndi PN akuphatikizapo taxanes (monga Taxol), ndi mankhwala a platinamu (monga Platinol ndi Paraplatin). Popeza kuti izi zimagwiritsidwa ntchito nthawi zambiri, zotsatira zimatha kukwezedwa.
Pali maphunziro ambiri omwe akupitiriza kuyang'ana njira zochepetsera chizindikiro ichi (monga kugwiritsa ntchito L-glutamine panthawi ya chithandizo), ndipo anthu ayenera kuyankhula ndi madokotala awo za kafukufuku wam'mbuyo asanayambe mankhwala a chemotherapy.
Mankhwala Opanga Mafuta
Mankhwalawa amagwiritsira ntchito mphamvu zamagetsi kuti azichiza maselo a khansa ndipo amagwiritsidwa ntchito limodzi ndi mankhwala a chemotherapy. Mankhwala othandizira ma ARV angagwiritsidwenso ntchito pothyoka (onani m'munsimu). Amaperekedwa m'njira ziwiri zoyambirira:
- Mazira a kunja kwazeng'onoting'ono: Kutentha kwapansi kwa mawonekedwe akunja ndi mawonekedwe omwe anthu ambiri amawadziwa, ndipo angapatsedwe tsiku ndi tsiku kwa masiku angapo kapena masabata.
- Mankhwala othandizira mazira a brachytherapy (mkati): Ndili ndi brachytherapy, mapuloteni amatha kuti ma radiation athe kuikidwa pafupi ndi chotupacho mkati mwake. Amagwiritsidwa ntchito mobwerezabwereza monga mankhwala othandizira kuti azitha kumeza.
Mavuto Otsatira Mazira
Zotsatira zoyipa za mankhwala a radiation ku chifuwa ndi khungu lomwe limabweretsanso khungu ndi kuthamanga pamalo a radiation (ofanana ndi kutentha kwa dzuwa) ndi kutopa . Kuwala kwa chifuwa kungayambitsenso kutupa m'mapapo ( radiation pneumonitis ). Ngati simunatengedwe iwo akhoza kutengera fibrosis m'mapapo. Kutupa kwa mphuno ( pulmonary fibrosis ) kungathenso kuchitika.
Thandizo Lolinga
Mankhwalawa amawagwiritsa ntchito monga chemotherapy, koma mankhwalawa "amayang'aniridwa" motsutsana ndi njira yowonjezera ya maselo a khansa. Pachifukwachi nthawi zambiri amakhala ndi zotsatira zochepa kusiyana ndi mankhwala am'chimayi.
Cyramza (ramucirumab)
Cyramza ndi anti-monoclonal antibody yomwe imatengedwa ngati angiogenesis inhibitor. Kuti zotupa zikule, ayenera kupanga mitsempha yatsopano ( angiogenesis ). Mankhwalawa amaletsa sitepe yoyenera kuti apange zombo zatsopano.
Cyramza imagwiritsidwa ntchito nthawi zambiri pamene mankhwala ena sali othandizira ndipo angagwiritsidwe ntchito popanda kapena chemotherapy. Zotsatirapo zingaphatikizepo kupweteka kwa mutu komanso kuthamanga kwa magazi koma nthawi zina zizindikiro zoopsa, monga kutaya magazi kwambiri kapena m'mimba zimatuluka.
Malinga ndi kafukufuku wa 2017, kuchokera ku mankhwala onse a chemotherapy ndi njira zomwe zakhudzana ndi chithandizo chomwe chilipo, Cyramza anasonyeza bwino kuti ali ndi mphamvu zowonjezera kupulumuka kwaulere komanso kupulumuka kwa anthu omwe ali ndi stade 4) yodzitetezera adenocarcinoma.
Herceptin (trastuzumab)
Herceptin amagwiritsidwa ntchito nthawi zina kuti apititse patsogolo ayophageal adenocarcinomas omwe ali HER2 zabwino (ofanana ndi khansa yabwino ya HER2 yabwino).
Kuyesera kwa HER2 kumachitika pa chitsanzo cha chotupa chomwe chinaperekedwa pa biopsy kapena opaleshoni. Mankhwalawa ali ndi mapuloteni HER2 pamwamba pa selo, komwe kukula kumakhudza ndi kumayambitsa kukula. Herceptin amamangiriza ku mapulogalamu awa kuti zinthu zowonjezera zisathe, makamaka matenda a khansa.
Zotsatira zake zimakhala zofewa, monga mutu ndi malungo, ndipo nthawi zambiri zimakhala bwino. Mankhwalawa, nthawi zina, amachititsa mtima kuwonongeka. Dokotala wanu adzakambirana za chiopsezo cha izi.
Mayesero Amakono
Pakalipano mayesero ochipatala akuyang'anitsitsa kuyang'anizana kwa mankhwalawa, komanso mankhwala atsopano monga mankhwala osokoneza bongo.
Ngakhale kutenga nawo mbali pa kafukufuku kungawopsyeze anthu ena, zimathandiza kukumbukira kuti mankhwala onse omwe tili nawo lero omwe ali ndi khansa yowopsya adayesedwa kale mu mayesero a zamankhwala.
Mankhwala Ophatikiza (CAM)
Pakalipano, palibe njira zothandizira kuti zitha kupulumuka kapena zithetsa anthu omwe ali ndi khansa yofooka. Izi zinkati, mankhwala ena amathandizira zizindikiro za khansa ndi mankhwala a khansa pamene ali ndi mankhwala ochiritsira.
Matenda ambiri a khansa tsopano akupereka mankhwala ena opatsirana khansa komanso mankhwala opatsirana khansa. Njira zochizira monga kusinkhasinkha, yoga, kupopera mankhwala, kupatsira misala, ndi zina zambiri nthawi zina zimathandiza anthu kuthana ndi mavuto omwe akukumana nawo ndi matenda a khansa.
Chisamaliro chosakanikirana
Kusamalidwa mosiyana kumasiyana ndi chisamaliro cha alendo kotero kuti chingagwiritsidwe ntchito ngakhale kwa anthu omwe amayembekeza kuchiritsidwa ku khansa yawo. Ndi chisamaliro chomwe chimakhudza kuthandiza anthu kuthana ndi zizindikiro zakuthupi ndi zamaganizo zokhudzana ndi khansa ndi mankhwala a kansa, kuyambira ku ululu wa khansa mpaka kuvutika maganizo.
Kuvuta kumeza chifukwa cholepheretsa chifuwa chachikulu ndi chotupa ndi chofala ndi khansa yowopsya ndipo imadwalitsa zakudya zoyenera. Ngati chotupa chiri chapamwamba kwambiri kwa opaleshoni (esophagectomy) pakadalibe njira zothetsera mavuto ndi kumeza. Ena mwa awa ndi awa:
- Kuika stent pamimba (kupyolera kumapeto) kuti musatsegulidwe.
- Brachytherapy (mkati mwa ma radiation) tawonedwa pamwambapa.
- Njira yothandizira mazira.
- Electrocoagulation (kuwotcha malo otupa omwe amachititsa kuti asokonezeke).
- Laser mankhwala.
Ambiri omwe ali ndi khansa tsopano akuthandizana ndi gulu lothandizira. Kugwira ntchito ndi katswiri wothandizira pafupipafupi nthawi zambiri kumapangitsa kuti zizindikiro zanu zikhale bwino komanso kuti moyo wanu ukhoza kukhala wabwino ngati mukukhala ndi khansa.
> Zotsatira:
> Bast, R., Croce, C., Hait, W. ndi al. Holland-Free Cancer Medicine. Wiley Blackwell, 2017.
> Janmaat, V., Steverberg, E., van der Gaast, A. et al. Kachilombo ka Chemotherapy ndi njira zochiritsira zogwiritsira ntchito matenda osokoneza bongo komanso odwala matenda opatsirana pogonana. Dongosolo la Cochrane la Zosintha Zogwirizana . 2017. 11: CD004063.
> National Cancer Institute. Matenda a Esophageal Cancer Treatment (PDQ) -Health Professional Version. Kusinthidwa 02/06/18.
> Speicher, P., Englum, B., Ganapathi, A. et al. Kupita ku Bukhu Lalikulu-Buku Lophatikizidwa Ndilo Kupititsa patsogolo Kupulumuka kwa Odwala Ndi Khansa ya Esophageal. Annals of Surgery . 2017. 265 (4): 743-749.